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2014 -04 -09 12:05 CP Rail <br />Alcohol & Gambling Enforcement <br />Name of organization <br />6517783620 » P 1/1 <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />444 Cedar Street, Suite 222, St. Paul, MN 55101 <br />651 - 201 -7500 Fax 651-297-5259 TTY 651 -282 -6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />---TO 4.DAY TEMPORARY ON -SALE LIQUOR- LICENSE - <br />5T. 3nb.i Tlrk- tutst xGf -4 yr LI11tt eQ -0.04 <br />Address <br />2.4 71 1 f:zrtt.A y.Mv SIA4a1- <br />Name of person making adpllcation <br />City <br />Date organized <br />1 InNufA- 1 iron <br />I <br />State <br />LI'nl4 drrd/61r <br />�4A.J 4rn +vt. <br />Date(s) of event <br />Apart_ 2st^ r xofy <br />Organization officer's name <br />Tax exempt number <br />2. Mar <br />2i. Code <br />Home phone <br />Minnesota <br />Business phone <br />4,9(• 231• o905 <br />LS/ e 24$- 3'l•(c <br />Type of organization <br />0 Club 0 Charitable tg Religious 0 Other non-profit <br />City State Zip <br />X <br />Icsrt}.p Tfk•tres Bn-wupp- <br />LttTVt loorDas- <br />Add New Officer <br />Macy re-4-1 vMwn l <br />Location where permit will be used. If an outdoor area, describe. <br />plhrrwte . .`+@4iov4. 4-.4b, 5•P'-d4., Lvma.104't'+-j 4. - 'rttia444 sArte4. <br />41,50" I ovt D+oAS jai $tt*v.— Pan? 4w .',JA . <br />If the applicant will contract for Intoxicating liquor service give the name and address of the liquor license providing the service, <br />z-i rLt cMr+A•a'rl <br />'71- 77 7- <br />µ�k <br />If the applicant will carry liquor liability Insurance please provide the carrier's name and amount of coverage. <br />'tot $ktfr /A/ 5,41-4.h Tifnrvcrb# 14+,41-Drudan or Sr. 17m'w'rgweJiA- Peas, <br />PPonrnrt &bot int -nob 8N etrt}i°ttt Mufti, <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUMMING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City/County Date Approved <br />City Fee Amount Permit Date <br />Date Fee Paid <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />NOEL: Submit this forrn to the city or county 30 days prior to event. Forward application signed by city and /or county to the address <br />aboVn, If I he application is approved the Alcohol and Gambling Enforcement Division will return this application to he used as the <br />permit for the event, <br />Pagel of 1 <br />4 <br />